‘The YMCA Problem’

(From O’Shaughnessy’s News Service) — In mid-August Dale Gieringer, the longtime director of California NORML, invited some 15 pro-cannabis colleagues to a zoom meeting to discuss what had been dubbed “the YMCA Problem” – as in Youthful Medical Cannabis Abusers. An intrepid and principled organizer, Gieringer had decided to take action after hearing Sherry Yafai, MD, say that in the past year she had observed a troubling upsurge in use of extremely potent pot products by young people.

Yafai is an Emergency Medicine physician at Providence St. John’s Medical Center in Santa Monica who, since 2017, has had a cannabis-focused private practice. When she first entered the field, she was the medical director of a sober living program in which patients would substitute cannabis for opioids and other highly addictive and deleterious drugs. Her patients used low or moderate amounts of cannabis to help them stay off their destructive drug(s) of choice. Yafai did not foresee that cannabis itself would become a problem drug and that “Cannabis Use Disorder” would become widespread among young people. But she was quick to pick up on the trend and to understand how online “recommendation mills” were enabling under-21-year-olds to buy high-THC products (both edibles and high-potency vape pens) at dispensaries that presumably catered to medical users.

Gieringer’s invitees formed an “Underage Inappropriate Access Working Group” to devise a strategy for coping with the YMCA phenomenon. Bonni Goldstein, MD, responded to the first wave of tactical suggestions with the incisive critique quoted below. Goldstein had been a pediatrician for years before becoming a cannabis specialist, and her patients are mostly severely ill children with epilepsy, cancer, and autism. She never ignores economic reality.

1) I am 100% against any requirement for those under 21 to have to get the state card as this means that my pediatric patients, which for the most part are the sickest of the sick with cancer, intractable epilepsy and severe autism (all of which costs a fortune out of pocket), will have to spend another $150 per year ($100 for patient plus $50 for caregiver for the card) because of the bad players taking advantage of the system.

2) I am also against higher taxes on higher THC products.  Many of my autism and cancer patients are using high doses of THC tincture/concentrated oils (>25%THC) in addition to other cannabinoids and should not be financially penalized for this appropriate medical use of THC.  Additionally many chronic pain patients who have been able to discontinue opioids with use of concentrates would be negatively affected by added taxes. (Remember pain pills are paid for by insurance; we should try to support those who have been able to lower or discontinue pain meds, not raise taxes on them.)

3) I have previously mentioned my resistance to putting dosing on recommendations, as first this is akin to a prescription (illegal), but additionally, this will be very challenging logistically.  Most patients have to try different products/dosages to find what works.  Changing specific dosing on a frequent basis (which is typical when someone initiates a medical cannabis regimen) creates a burden for both physicians and patients.

By September the group had decided to alert the Medical Board of California to the impact of the recommendation mills, hoping that they would take appropriate action. Goldstein, with input from Yafai and Jeffrey Hergenrather, MD, are drafting a letter to Attorney General Rob Bonta. (The AG’s office prosecutes doctors who run afoul of the med board.) Governor Gavin Newsom will be cc'ed. Both he and Bonta had a hand in making cannabis “legal” in California – an obvious fiasco. Both are ambitious, and an epidemic of “Cannabis Use Disorder” among young people might tarnish their images.

Retrograde Messages

In Tod Mikuriya’s great paper on Cannabis as a Substitute for Alcohol – probably the best thing that will ever be written on the subject – he cites a British psychiatrist named Carstairs who in 1951 studied the two highest castes in a large village in Northern India, the Rajputs (warriors and governors who drank a potent distilled alcohol called daru) and the Brahmins (religious leaders who were vegetarians and drank a cannabis infusion called bhang). Mikuriya observed: ”The disinhibition achieved via alcohol is the Rajput kind — a flight from reality, becoming ‘blotto’ — whereas the disinhibition achieved via cannabis is the result of focused or amplified contemplation.”

Nowadays, manufacturers can produce 100 milligram capsules of cannabis that make the user blotto – the effect many YMCAers want to achieve.

Among US teenagers, there’s a terrible epidemic of despair. Girls are slashing themselves and killing themselves. More than one in 10 US schoolchildren have ADHD diagnoses. One in 12 boys is a sociopath, according to a Rhode Island state health official. One in 44 US children have been diagnosed with ASD (Autism Spectrum Disorder). Only one in four are fit to serve in the military at age 18. Most who “volunteer” are fleeing futures devoid of hope. Even the middle-class kids and the rich kids know that Eden is burning.

What percentage of teenage girls who slash themselves are heavy cannabis abusers? The study will never be conducted because nobody stands to make money by learning the results. What percentage of teen suicides are heavy cannabis abusers? The sad reality is that YMCAers are people who desperately want to get fucked up. And if they can’t do it on megadoses of THC, they’ll find some other way. Most of the available methods – alcohol and opioids – are more deleterious than megadoses of marijuana.

Dale Gieringer agrees that the upsurge in high-dosage marijuana intake “might be related to the national malaise. On the other hand,” he insists, “18 year olds shouldn’t be going into dispensaries and buying ‘shatter’ on medical recommendations since those substances aren’t even medically prescribable. The doctors say they would never recommend dabbing or high-potency hashish except in severe cases of childhood epilepsy and cancer, when they might prescribe 100 milligram capsules. They wouldn’t prescribe these other things that give you a huge rush.”

There’s no arguing with that. But sometimes I think if it wasn’t for unintended consequences there wouldn’t be any consequences at all.